Calcified nodule: A rare but important cause of acute coronary syndrome with worse clinical outcomes

Sato, Yu; Finn, Aloke V.; Virmani, Renu

doi:10.1016/j.atherosclerosis.2020.12.009

Cited by 9 publications

(7 citation statements)

References 10 publications

(11 reference statements)

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“…Notably, 73% of the lesions with CD‐TLR in the CN group had in‐stent CN, whereas none of the lesions with CD‐TLR in the non‐CN group had in‐stent CN. This result is in line with previous pathological data, which showed that in‐stent CN was observed in more than three quarters of the lesions with TLR in CN lesions 4,25 . In general, neointimal hyperplasia and stent underexpansion are the leading causes of in‐stent restenosis 26 .…”

Section: Discussionsupporting

confidence: 91%

“…This result is in line with previous pathological data, which showed that in-stent CN was observed in more than three quarters of the lesions with TLR in CN lesions. 4,25 In general, neointimal hyperplasia and stent underexpansion are the leading causes of in-stent restenosis. 26 However, our results demonstrated that in-stent CN is an important alternative mechanism of in-stent restenosis in HD patients with CN lesions.…”

Section: Clinical Outcomes In Cn Groupmentioning

confidence: 99%

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Impact of calcified nodule on target lesion failure after stent implantation in hemodialysis patients

Matsuhiro

Nakamura

Dohi

et al. 2023

Cathet Cardio Intervent

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Background: Little is known about intravascular imaging predictors of cardiac events after drug-eluting stent (DES) implantation in hemodialysis (HD) patients. We aimed to reveal the association between calcified nodules (CN) and target lesion failure (TLF) in HD patients after DES implantation.Methods: We enrolled 114 HD patients who underwent DES implantation between October 2016 and October 2020. The patients were divided into a CN group (39%, 44 patients) and a non-CN group (61%, 70 patients). The primary endpoint was the incidence of TLF, including cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization.Results: HD duration was longer, and the calcium burden was higher in the CN group than in the non-CN group. Over a median follow-up of 607 days [interquartile range: 349-965 days], the cumulative incidence curve showed that the CN group had a significantly higher incidence of TLF than the non-CN group (31.8% vs. 11.4% within 3 years, p = 0.008). On Fine-Gray sub-distribution hazard model analysis, the CN group was associated with an increased rate of TLF (hazard ratio [HR]: 2.86; 95% confidence interval [CI]: 1.21-6.75, p = 0.016). An in-stent CN was observed in 73% of the lesions with target lesion revascularization in the CN group, whereas no in-stent CN was observed in the non-CN group (p = 0.026).Conclusions: CN was an independent predictor of TLF in patients undergoing HD.In-stent CN was an important cause of TLF after DES implantation in CN lesions in HD patients; therefore, a different strategy should be considered for treating the lesions.

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Section: Discussionsupporting

confidence: 91%

Section: Clinical Outcomes In Cn Groupmentioning

confidence: 99%

Impact of calcified nodule on target lesion failure after stent implantation in hemodialysis patients

Matsuhiro

Nakamura

Dohi

et al. 2023

Cathet Cardio Intervent

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“…The major findings of the present in vivo study were (1) that serum ALP level and total plaque volume were independently associated with the prevalence of CN in CAD patients with calcified plaques, (2) plaques with CNs had more severe diameter stenosis, higher mean plaque burden, and plaque density, but lower lipid percentage and fiber percentage as compared with non-nodular calcified plaques, and (3) the mean plaque burden is an independent predictor of the prevalence of CN in calcified plaques.…”

Section: Discussionmentioning

confidence: 68%

“…Author details 1 Department of Cardiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.…”

Section: Abbreviationsmentioning

confidence: 99%

“…Non-invasive imaging offers a screening tool to identify plaques with features of vulnerability, stratifying patients at increased cardiovascular risk. The coronary calcified nodule (CN) is suggested as a potentially vulnerable plaque accounting for approximately 2% to 7% of coronary events with worse clinical outcomes [ 1 ]. CN on intravascular ultrasound (IVUS) is an eruptive, dense, calcified mass that usually has an irregular surface appearance [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Serum marker and CT characteristics of coronary calcified nodule assessed by intravascular ultrasound

Jian²,

Wu³

et al. 2022

BMC Cardiovasc Disord

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Background Calcified nodule (CN) is a type of potentially vulnerable plaque. Its formation mechanism remains unknown. This study was to assess serum marker and computed tomography angiography (CTA) characteristics of CN validated by intravascular ultrasound (IVUS). Methods Patients who underwent coronary CTA followed by invasive coronary angiography and IVUS were retrospectively analyzed. Serum levels of alkaline phosphatase (ALP), gamma-glutamyltransferase, and calcium were collected. Results IVUS detected 128 de novo calcified lesions in 79 patients with coronary artery disease (CAD). CNs were identified in 11.4% (9/79) of patients and 9.4% (12/128) of lesions. Compared with patients with non-nodular calcified plaques, CN patients had higher serum level of ALP (82.00 vs 65.00 U/L, P = 0.022) and total plaque volume (673.00 vs 467.50 mm3, P = 0.021). Multivariable analyses revealed that serum ALP level and total plaque volume were independently associated with the prevalence of CN in CAD patients with calcified plaques. At lesion level, the CN group had a higher frequency of moderate to heavy calcification on angiography (75.00% vs 40.52%, P = 0.017). In terms of CTA characteristics, plaques with CN had a more severe diameter stenosis (79.00% vs 63.00%, P = 0.007), higher plaque burden (85.40% vs 77.05%, P = 0.005), total plaque density (398.00 vs 283.50 HU, P = 0.008), but lower lipid percentage (14.65% vs 19.75%, P = 0.010) and fiber percentage (17.90% vs 25.65%, P = 0.011). Mean plaque burden is an independent predictor of the prevalence of CN in calcified plaques (odds ratio = 1.102, 95% confidence interval: 1.025–1.185, P = 0.009). The AUC is 0.753 (95% confidence interval: 0.615–0.890, P = 0.004). When using 84.85% as the best cutoff value, the diagnostic sensitivity and specificity of mean plaque burden for predicting the presence of CN within calcified plaques were 66.7% and 80.2%, respectively. Conclusions CN had different CTA imaging features from non-nodular coronary calcification. The presence of a CN was associated with a higher serum ALP level and plaque burden.

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Incidence and prognostic impact of the calcified nodule in coronary artery disease patients with end-stage renal disease on dialysis

et al. 2022

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Calcified nodule: A rare but important cause of acute coronary syndrome with worse clinical outcomes

Cited by 9 publications

References 10 publications

Impact of calcified nodule on target lesion failure after stent implantation in hemodialysis patients

Impact of calcified nodule on target lesion failure after stent implantation in hemodialysis patients

Serum marker and CT characteristics of coronary calcified nodule assessed by intravascular ultrasound

Incidence and prognostic impact of the calcified nodule in coronary artery disease patients with end-stage renal disease on dialysis

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